Picking Up The Pace of Change

Long-term care (LTC) in the U.S. varies enormously by state, even though all states are heavily dependent on the federal/state medicaid program for funding. About 15 states have done a good job over the last two to three decades in developing relatively efficient LTC systems that increasingly offer older and younger impaired persons options in the community for receiving LTC services rather than in nursing homes. The best state, according to these AARP rankings, is Washington (which has a very balanced, efficient system.) Florida, on the other hand, is ranked 46th in the quality of its LTC system.

The Long-Term Services and Supports (LTSS) State Scorecard—a compilation of state data and analysis—finds that progress toward better support for our rapidly increasing populations that are aging and living with disabilities is slow and uneven, with great variation among states. Still, states made significant improvements in supporting family caregivers, providing more home- and community-based services, and reducing burdensome care transitions from one care setting or provider to another. The two areas with the most significant progress are reduction in the use of antipsychotic medications that are given “off label” for nursing home residents whose conditions do not support their use (48 states) and movement toward person- and family-centered practices that support family caregivers (42 states). The two areas with the most significant declines are employment for working-age people with disabilities (21 states) and long-stay nursing home residents moving back to the community (21 states).

Although states have improved more than they have declined, this progress is not enough. Each year, for example, states inch toward spending a greater proportion of Medicaid and state LTSS funding on home- and community-based services—a positive trend because it both enables greater independence and is cost-effective. At the current national rate of change, however, it will take 36 years for the average of the bottom 5 states (17 percent toward home- and community-based services) to reach the level of the median state today (33 percent), and another 51 years for the median state to reach the level of the average of the top 5 states (64 percent). To hit these benchmarks by 2026—the year when baby boomers begin to turn 80 and begin to experience a greater need for LTSS—the rate of improvement must triple and quadruple, respectively.

Read the full report here.